In children of feeble constitution, or reduced by chronic disease, the fever may assume very malignant characters. When the attack comes on the patient becomes stupid and drowsy, and then quickly passes into a state of coma from which he never revives. Such cases are never seen in England. Dr. Lewis Smith states that he has twice met with this form of the disease, and that in each instance the attack proved fatal.
Children who live in malarious districts often exhibit signs of ill-health without suffering from actual attacks of fever. Such patients are thin and weakly ; the skin is of a peculiar pale bistre tint ; the mucous membranes are pallid ; the appetite is poor, and the bowels are costive or relaxed. The spleen is permanently enlarged and hard. If the anmmia is extreme, codeine of the legs and ankles may be noticed. Sometimes, however, cedema in these cases is due to disease of the kidneys ; for I.minaturia and albuminuria are said to be not uncommon symptoms in children living in ague-breedino. neighbourhoods. Indeed, in countries where malarious fever is prevalent the origin of Bright's disease in the child is frequently attributed to a previous attack of ague. Catarrhal pneumonia is said sometimes to complicate the illness and may even pass into confirmed phthisis.
The more obscure forms of malarious fever, which are not uncommon in the adult, in the child are very rare. Brow ague is unknown. Bohn, however, states that he has met with an intermittent torticollis which he believed to be referable to a miasmatic cause, and Dr. Gibney has de scribed an intermittent spinal paralysis also of malarious Diagnosis.—When the disease assumes the ordinary form met with in the adult it is easily recognised ; but when, as often happens, especially in infants and the younger .
er children, the stages are imperfectly marked and the symptoms indefinite, there is much difficulty in the diagnosis. If the case occur in an ague-breeding district, sudden illness and prostration with a high temperature should always excite our suspicions, especially if no evident cause, such as vomiting or diarrhcea, exists to explain the alarming symptoms. Afterwards the sudden fall in the temperature which occurs at the end of the hot stage, and the rapid return of apparent health as the attack passes off—these symptoms, combined with enlargement of the spleen, are very suggestive of malarious origin. When on the next day, or the day after, the same phenomena recur, ending as before in apparent recovery, the nature of the illness can no longer be misapprehended.
Fits of ague sometimes occur in children who are not at the time living in a malarions district. If we were suddenly called to a child of whom we had no previous knowledge, and found him looking ill with a very high temperature and signs of severe general weakness, we should be justified in regarding his condition with grave apprehension ; for the fact of his having been lately exposed to the ague poison would probably not be re ferred to. In such a case, after a careful examination of the patient, we should be able to come to no conclusion, and might probably suspect the onset of one of the exanthemata. It would be only on the next visit, on finding the patient whom we had left in so apparently serious a state look ing and feeling well, with a normal temperature, that the nature of the illness would suggest itself to our minds.
If, during the hot stage, the body becomes covered with a bright red. rash, this symptom, combined with the high temperature and perhaps slight redness of the throat, may raise strong suspicious of scarlatina. If, how ever, we are aware that the phenomenon may occur, and find that the rash subsides and the temperature falls completely in the course of a few hours, we should reserve a positive opinion as to the real nature of the eruption. When, later, the same phenomena are exactly reproduced, the nature of the case can be no longer doubtful. Dr. Cheadle has reported two such cases. In one—a child aged two years and nine months—the illness began at 9 A.m. with a sharp rigour. A hot bath which was immediately given brought out a bright red rash all over the body. At the same time the skin was dry and burning, the temperature 102', and the pulse 110. There was no soreness of the throat. At the.end of three hours the rash faded, and the next day the child was playing about as usual. On the fol lowing day—the third—an exactly similar attack took place ; and later the phenomena were again repeated a third time. Quinine was then given, and the ague fits quickly came to an end. In a case such as the above, if there is no redness of the throat the resemblance to scarlatina is less close. Even if the throat is sore, the peculiar punctiform redness of the soft palate which is so common in scarlatina is wanting ; and, moreover, the redness in the fauces is less generally diffused.